Provider Demographics
NPI:1578124475
Name:MATHEW, LIJI (DMD, MDS)
Entity Type:Individual
Prefix:DR
First Name:LIJI
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24626 KINGSTON HILL LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4581
Mailing Address - Country:US
Mailing Address - Phone:469-410-9223
Mailing Address - Fax:
Practice Address - Street 1:1744 FRY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5801
Practice Address - Country:US
Practice Address - Phone:469-410-9223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice